• Real-World Effect of Anti-VEGF Drugs on IOP

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, May 2018

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    In a review of IRIS Registry data, Atchison et al. looked at intraocular pressure (IOP) in eyes treated with an anti–vascular endothelial growth factor (anti-VEGF) agent and compared that with IOP levels in untreated fellow eyes. They found that treatment generally resulted in a small but significant de­crease in IOP; however, some treated eyes had substantial elevation of IOP.

    For their study, the authors identified 23,776 patients who received at least 12 injections of a single anti-VEGF drug (aflibercept, bevacizumab, or ranibizumab) in their right eye. Left eyes were not treat­ed. Diagnoses were neovas­cular age-related macular degeneration (AMD) only (73%), diabetic macular edema only (12%), vein occlusion with macular edema (11%), and a combi­nation of these conditions (4%). The minimum follow-up period was 1 year.

    Primary outcome measures were IOP change from baseline and the propor­tion of eyes with a clinically significant increase in IOP, defined as a sustained increase of at least 6 mm Hg resulting in IOP > 21 mm Hg. Subgroup analyses were conducted among patients with AMD only and patients who did not have anti-VEGF treatment in the year before study entry.

    Mean IOP declined from baseline to ≥ 1 year in all treatment arms, including subsets. Overall, the mean decrease was 0.9 mm Hg for treated eyes and 0.2 mm Hg for untreated eyes. A generalized linear model accounting for confound­ers showed that, in most groups, the degree of IOP lowering was less with bevacizumab than with aflibercept or ranibizumab.

    Clinically significant increases in IOP were sustained in 2.6% of treated eyes and 1.5% of untreated eyes; the rates by treatment were 1.9% for aflibercept, 2.8% for bevacizumab, and 2.8% for ranibizumab. The increases in untreated eyes were significantly lower than in eyes treated with bevacizumab and ranibizumab, but not with afliber­cept. The reason for this difference is unclear and requires further investiga­tion. Aflibercept is the only drug in this study with affinity for placental growth factor, which could affect the trabecular meshwork in a manner that is not yet known.

    The original article can be found here.